Exam 2 - Patient Care Methods

patient movement/handling + immobilization

purpose of patient transfer

safely move a patient from one place to another

safety of transfer

involves both the patient and people doing the trasnfer

why do we use proper transfer techniques?

reduce injuries + minimize low back pain

what is biggest cause of injury?

back pain

lifting with your back

good body mechanics

good posture

body’s line of balance close to COG - below waistline

hold object close to body

bend knees/lift with legs

don’t twist trunk

push don’t pull

requirements of proper patient handling

good BOS

aware of COG

correct muscles for mobility + stability

what is a supportive base?

feet are farther apart with supportive shoes

using core muscles for stability

base of support

wider stance improves BOS

feet flat on floor

center of gravity

hypothetical area where body mass is concentrated - gravity works from this area

at level of sacral segment

body’s COG over BOS for stability

mobility muscles

extremity muscles

use for lifting and stability during transfers

stability muscles

muscles of torso (core)

use for support during transfers

lifting principles

bending + straightening the knees

straight back or slight lordosis (no spine flexion)

allow ample time + gentle w/ patients

inform patient of what you’re doing

how to handle a transfer?

have someone be in charge

go on a count (1, 2, 3…)

have patients cross their arms + secure loose clothing

no hair or lanyards dangling

patients and lifting

let patient do as much work as possible

check chart to see any restricted weight-bearing status

might require transfer assistance?

cognitive impairments + dementia

lack judgement

how to use transfer belt?

explain transfer procedure

belt around patients COG

orthostatic hypotension

sudden drop in blood pressure caused by change in body position

more pronounced in patients who have been bedridden for extended periods

new meds can cause

orthostatic hypo symptoms

dizziness, fuzziness, fainting, blurred vision, slurred speech

normal + should subside quickly

team transfer techniques

someone take charge of of transfer

calls the “play”, controls timing, synchronizes transfer events

reviews procedures w/ team

atleast 2 people or more

wheelchair transfers

determine patient strong/weak sides

position patient transfers to strong side

lock wheelchair + move footrests + support back of chair

if patient can’t sit up for transfer?

stretcher transfer

portable exam sometimes

4 types of wheelchair transfers

standby assist

assisted standing pivot

two-person lift

hydraulic lift

standby-assist transfer

patients who can transfer from wheelchair to table on their own

provide movement instructions to patient continually during transfer

put patient at table at 45 degree angle + table height of chair seat

assisted standing pivot transfer

transfer belt

pt on edge of chair - push down on armrests

grasp belt, straight back + bend knees

rise w/ patient

when ready, pivot to table - pt holds table

two person lift

pt crosses arms + grasps secure surface (no reaching)

grasp under axillae + forearms

assistant squats + cradles calves

on command, lift + move as one unit

hydraulic lifts

patient too heavy for manual lift - still weight limit

adjustable BOS + lifting/transfer swing

manual release button

hydraulic lift technique

patient seated or recumbent on lift swing
check position + length of chain segments

2 people for lift - work lift or guide floating pt

cart transfers

lock cart wheels - surfaces close + same height

3 people + transfer aids; side to side transfer

patient assists if able

cart transfer ratio

every 50 lbs is 1 person

1 person : 50 lbs

transfer aids

sliding sheets

inflatable

slide board

cart to table transfer

roll pt toward you - transfer device + draw sheet under pt

roll pt back - ensure pt on device

gently pull draw sheet + pt on table

patient transfer with draw sheet

roll draw sheet on both sides

director: head + upper body - far side of table

assistants: pelvis - cart side + legs - table side

pt arms crossed

skin damage from transfers

occur in as little as 1-2 hrs

going from diff types of surfaces + mechanical factors

elderly more vulnerable

who is more prone to skin damage?

elderly

immobile patients

quick exams/time on table

decubitus ulcer

skin breakdown/ulcer

circulation to skin is cut off

recumbent positions

supine, prone, lateral, sims, fowler

sims position

lateral w/ knee up

fowler position

head is elevated

Trendelenburg position

feet higher than the head

patient positioning considerations

explain procedure to pt

let pt assist if able

check w/ pt before any move

roll pt toward you

provide sponges

work as transfer team

what is most significant factor to unacceptable images?

motion distortion

also positioning inaccuracies

immobilization principles

communicate

shortest exposure time

immobilization aids

empathy w/ pt condition

aids can leave artifacts

immobilization devices

positioning sponges, sheets, sandbags, velcro strap restraints, head clamps, commercial devices

cervical collar, spine board, splints, sheet restraints, tape

what thicker items show on images?

blankets, quilts, jean seams, etc.

cervical collar

neck injury

NEVER take if off

Dr has to clear it

backboard

do not take them off the board

x-ray them on the board

casts

x-ray through the cast

splints/sheet restraints

removable for x-ray

tape

not directly on skin

wash cloth over skin before tape

hold anatomy in certain place

positioning sponges

increased accuracy by supporting patient or anatomic area of interest

make sure sponges free of artifacts

radiolucent

sandbags

hold down structure

stockinette

stretchable cotton fabric pulled over fracture before plaster cast

effective as restraint

immobilizing upper limbs above/behind child’s head

stability bar

control many degrees of motion

hold bar during lateral - stabilization

most common spinal trauma traction?

cervical collar for spinal trauma

spine trauma

cervical collar + backboard common

IR under backboard

immobilize patients

pediatric immobilization

communicate + build rapport

kindness, patience, on child level

threats/force avoided at all times

work w/ parents to calm child

parent wants to stay in room during image?

give lead

ask if pregnant, just in case

infant sheet restraints

effective, simple, inexpensive, reliable method for immobilizing child

commercial restraints

upright - pig o stat + pedia-poser

restraint board - contour-fitting pad with velcro strap

reduces motion → reduce exposure

pig o stat

4-6 months

baby needs head control

2 people to put child in + tight hold

pedia-poser

for bigger kids

octostop restraint board

rotated 360 deg into 8 positions

radiolucent + durable backboard w/ straps

up to 1 yr old

geriatric patients

communicate + extra care to make pt feel secure

exam comfort + keep warm

work smoothy, reassure, dont rush

greatest fear of geriatrics?

falling